BACKGROUND: High adherence to the enhanced recovery after surgery pathway reduces morbidity and mortality rates after elective colorectal surgery. OBJECTIVE: To evaluate the effect of adherence to the enhanced recovery after surgery pathway on the failure to rescue rates after elective colorectal surgery. DESIGN: Retrospective analysis of a prospective database. PATIENTS: Adults (≥ 18 years old) who underwent elective colorectal resection with anastomosis for benign and malignant disease. SETTINGS: Prospective enrolment in 78 centers in Italy from 2019 to 2021. INTERVENTIONS: All the outcomes were measured at 60 days after surgery. Several patient-, disease-, treatment-, hospital-, and complication-related variables were analyzed for the outcomes. After univariate analyses, independent predictors of the endpoints were identified through logistic regression analyses, presenting odds ratios and 95% confidence intervals. MAIN OUTCOME MEASURES: Failure to rescue after any adverse event, defined as the ratio between the number of deaths and the number of patients showing any adverse event
failure to rescue after any major adverse event, with the denominator represented by the number of patients showing any major adverse event. RESULTS: An adverse event was recorded in 2,321 out of 8,359 patients (27.8%), a major adverse event in 523 patients (6.3%), and death in 88 patients (1.0%). The failure to rescue rates were 3.8% after any adverse event and 16.8% after any major adverse event. Independent predictors of primary endpoints were identified among patient- (age, American Society of Anesthesiologists class, nutritional status), treatment- (type of resection), and complication-related (anastomotic leakage, reoperation) variables. Enhanced recovery pathway adherence >
70% independently reduced failure to rescue rates. LIMITATIONS: Clustering from multicenter data, and unmeasured confounding from observational data. CONCLUSIONS: Following elective colorectal resection, adherence >
70% to the enhanced recovery pathway independently decreased failure to rescue rates, along with other patient- or treatment-related factors. See Video Abstract.